Health Behaviors Of Patients Research Articles

Patient Prototypes

Abstract. Despite large bodies of research examining perceptions of illnesses and perceptions of people who engage in various health behaviors, very little research has examined perceptions of people who have a specific illness. The aims of this research were to create a measure of “patient prototypes,” mental representations of the type of person who has a specific illness, and to examine their associations with other health cognitions and behaviors. Two survey studies (Study 1: N = 208 and Study 2: N = 246) assessed patient prototype favorability for three illnesses (skin cancer, Human papillomavirus (HPV), and type 2 diabetes) as well as constructs from the common-sense model and prototype willingness model. Patient prototypes for the three illnesses were distinct in terms of specific traits and overall favorability. Generally, patient prototype favorability was unrelated to illness representation dimensions in the common-sense model but was positively associated with some constructs in the prototype/willingness model. All three prototypes were positively correlated with perceived vulnerability. The skin cancer prototype was positively correlated with measures of behavioral willingness, behavioral intention, and actual health behavior (UV exposure). Limitations include the use of young adult participants who have relatively little experience with the illnesses examined. Measures of patient prototype favorability and health behaviors need to be further examined and refined. The novel construct of patient prototype favorability provides a foundation for future inquiry into the role that patient perceptions play in health behavior and the implications for the prototype/willingness model and the common-sense model.

Oral health of high-cost patients and evaluation of oral health measures as predictors for high-cost patients in South Korea: a population-based cohort study

ObjectiveTo examine the oral health conditions and oral health behaviour of high-cost patients and evaluate oral health measures as predictors of future high-cost patients.DesignA retrospective, population-based cohort study using administrative...

Abstract P2058: Using Mobile Health Technology to Increase Knowledge About Hypertensive Patients Requests and Health Behaviors

Background: The use of virtual health intervention and the use of home blood pressure monitoring (HBPM) has been shown to improve empowerment, compliance and blood pressure control. Aims: The aim of the present study was to use a smartphone application for hypertension treatment to investigate the patients' perception of how hypertension affected their lives. Methods: The target group was patients with primary hypertension without diabetes or major cardiovascular complications living in Stockholm, Sweden (males/females 132/153, mean age 58 years). When a patient had been included, a smartphone application (Accumbo, Sweden) was downloaded. HBPM were measured with a Bluetooth connected oscillometric BP monitor. A questionnaire was filled in electronically. Results: Mean blood pressure was 135/87 mmHg. Based on the questionnaire 71 % (190 out of 267) of the patients had never received information from their doctor regarding the aetiology of their disease. Only 37 % (103 out of 277) had received individual health advice. When asked “How is your health in general”? 54% (154 out of 285) responded good or very good. On the other hand 47% (128 out of 281) of patients answered that having an elevated blood pressure affected their daily activities. Most patients, 79 % (222 out of 282) wanted to lose weight. Forty percent (110 out of 278) stated that they received little or very little daily exercise. Sixty eight % (190 out of 279) wanted to increase their daily physical activity if possible. Only 8% (26 out of 279) did not want to increase their daily exercise. Fifty six percent (156 out of 276) patients used a lifestyle or health app in their smartphone and 43 % (121 out of 280) patients had taken dietary supplements, or vitamins the month before the study. Conclusion: Few hypertensive patients had received individual lifestyle advice although the majority of patients had a desire for weight loss and increased physical activity. Most patients were aware of the complications of hypertension and the use of alternative therapies such as dietary supplements and health and lifestyle apps were very common. Traditional health care should increase the use of digital questionnaires in order to obtain increased information about patient's lifestyle factors for better targeted treatment.

Positive Orientation as a Predictor of Health Behavior during Chronic Diseases.

Background: Positive orientation includes optimism, self-esteem, and life satisfaction. This research was conducted to determine whether positive orientation is an important predictor of health behaviors of patients with chronic movement disorders which require a rehabilitation program. Methods: The study involved 93 patients, including 46 women (49.5%) and 47 men (50.5%). The study utilized a standardized Positive Orientation Scale and a Health Behavior Inventory to measure the intensity of health-promoting behaviors. Results: The two variables of age and positive orientation were found to be predictors of overall healthy behavior, explaining a total of 22% variance of the dependent variable. Age was a predictor of preventative behavior (β = 0.37; R2 = 0.16). Its share in the prediction of this variable was significant (16%). The highest predictive value of positive mental attitude was having a positive orientation (β = 0.42; R2 = 0.17), which explained 17% of the variance of the dependent variable. However, age explained 14% of the variability of health practice results (β = 0.39; R2 = 0.14). Conclusion: The results of the research indicate the need to implement preventive programs with a positive orientation to modify the health behavior of chronically ill male and female patients.

What Is the Effect of Health Coaching Delivered by Physical Therapists? A Systematic Review of Randomized Controlled Trials.

Health coaching has emerged as an intervention for improving health behaviors. Given the recent increased integration of health coaching into physical therapist practice, there has been a subsequent rise in research examining the effects of health coaching provided by physical therapists. However, there is a lack of literature summarizing the effectiveness of health coaching delivered by physical therapists in changing patient health behaviors. The purpose of this study was to systematically review the effects of health coaching delivered by physical therapists on promoting participant health behaviors. Cochrane, CINAHL, MEDLINE, PEDro, PsycINFO, and Web of Science databases were searched from inception to May 26, 2018, to identify randomized controlled trials examining the effects of health coaching delivered by physical therapists. Two reviewers independently screened titles, abstracts, and full texts according to inclusion and exclusion criteria to determine study eligibility. Methodological quality was assessed using Physiotherapy Evidence Database (PEDro) scores. Risk of bias was assessed using the Cochrane Collaboration risk-of-bias assessment tool. Data were extracted using a standardized data extraction form describing study methods, design, and outcomes. Eleven trials met the inclusion criteria for this study. Health coaching produced positive effects on physical activity (6 studies) as well as physiological and psychological secondary outcomes. The inclusion of only 11 randomized controlled trials in this review could limit the generalizability of the findings. The heterogeneity of the findings precluded the performance of a meta-analysis. Research on the effectiveness of health coaching delivered by physical therapists on health behavior outcomes is mixed. Data indicate statistically significant changes in some health behavior, physiological, and psychological outcomes.

Environmental factors affecting self-management of chronic hepatitis B from the patients' perspective.

To explore factors affecting self-management experiences of patients with chronic hepatitis B within their social and cultural environments. Many cases of hepatitis B are not detected until they are in end-stage liver disease. Despite an increasing trend of indicating a lack of health awareness as the reason, studies have rarely referred to the personal, social and cultural environmental constraints from patients' perspectives. A descriptive qualitative study. Forty-seven adults diagnosed with chronic hepatitis B were interviewed in a private area of a hospital clinic in Taiwan in 2018. Four open-ended questions relating to care self-management included the following: disease detection; disease control; preventive care; and perceptions of screening and follow-ups. Data were examined using content analysis. This study also adhered to the consolidated COREQ guidelines. Five main themes emerged: personal experiences, awareness of occupational health, the availability of conventional treatment, cultural beliefs about health care and family roles. Findings of note were that some participants became aware that they had never known the difference between follow-up for hepatitis B and regular adult/labourer health checks due to a lack of information within their living environment. Many participants added alternative treatments to their self-management strategies and others frequently ignored follow-up appointments because of different cultural health beliefs. Patients' disease self-management perceptions are driven by dynamic influences suggesting that development of policies integrating personal, family, social and cultural environmental factors could enhance individual screening and subsequent health behaviours of patients with chronic hepatitis B. Adding person-centred case management of hepatitis B could enhance patients' adherence to follow-up. Attention should be given to increasing provider awareness of the influence of their own attitude and communication on patients' participation in self-management.

Suicides and deaths linked to risky health behavior in childhood cancer patients: A Nordic population-based register study.

Childhood cancer survivors have been reported to be vulnerable to psychiatric morbidities and risky health behavior. Suicides, substance abuse, accidents, and violence as causes of death can be regarded as an extreme manifestation of risky health behavior. In the current study, the authors studied the risk of suicide and other risky health behavior-related deaths among childhood cancer patients in Denmark, Finland, and Sweden. Using linkage between national cancer, population, and cause-of-death registries, the authors investigated the causes of death in 29,285 patients diagnosed with cancer before age 20years between 1971 and 2009 compared with a cohort of 146,282 age-matched, sex-matched, and country-matched population comparisons. Rate ratios (RRs) with 95% CIs were estimated using Poisson regression models, adjusting for demographic factors. The overall risk of dying of a risky health behavior was found to be increased among childhood cancer patients (RR, 1.25; 95% CI, 1.06-1.47) when compared with population comparisons. The elevated risk was statistically significant among patients with central nervous system tumors (RR, 1.49; 95% CI, 1.08-2.05) and patients diagnosed at ages 5 to 9years and 15 to 19years (RR, 1.50 [95% CI, 1.01-2.24] and RR, 1.31 [95% CI, 1.03-1.67], respectively). The overall risk of suicide was found to be increased (RR, 1.37; 95% CI, 1.02-1.83), and statistically significantly so when patients were diagnosed between ages 15 and 19years (RR, 1.61; 95% CI, 1.09-2.39). Childhood cancer patients appear to have an increased risk of risky health behavior-related causes of death compared with the general population. The results of the current study suggest the importance of integrating psychosocial support into the follow-up care of these individuals.

Adapted motivational interviewing for brief healthcare consultations: protocol for a systematic review and meta-analysis of treatment fidelity in real-world evaluations of behaviour change counselling

IntroductionTreatment fidelity is an important and often neglected component of complex behaviour change research. It is central to understanding treatment effects, especially for evaluations conducted outside of highly controlled research...

Assessment of oral hygiene trends among dental patients in relation to chronic medical conditions by dental students. A cross-sectional study.

SummaryIntroductionThere is a lack of information about knowledge, attitude and behavior regarding oral hygiene and dietary habits of adult patients attending dental clinical settings. Hypertension, diabetes, obesity and caries are increasing among different populations, resulting in the deterioration of the quality of life related to oral and general health.ObjectivesTo involve second year dental students in assessing oral health knowledge, attitude, behavior, dietary habits and general health of dental patients, and screening for blood pressure, blood glucose level and obesity.Participants and methodsA convenient sample of 652 adult subjects participated in the study. They were screened, and involved in an interviewer - led questionnaire, led by the students over the period of two successive academic years (2013-2014 and 2014-2015).ResultsSubjects with high blood pressure and /or blood glucose levels were more likely to disagree regarding the presence of a relation between general health and dental health [(correlation coefficient (r) = – 0.159, probability value P < 0.001) (correlation coefficient (r) = – 0.257, probability value P < 0.001) respectively]. Subjects with high BMI were less aware of the importance of using the tooth brush in prevention of gingival inflammation. The overall students’ satisfaction score was 71.5%. The practical part of the research had the highest satisfaction score (83.7%).ConclusionsThere is scarcity of data regarding dental healthcare knowledge and attitudes in dental clinical settings. Additional clinical training for dental students would increase their willingness to play a preventive and educational role in the oral care of patients.

Dental health status and oral health behaviours of patients with facial burn in Pakistan

BackgroundThere is a limited understanding about the oral health of patients with facial burn, hence the aim was to describe the oral health status and the related risks factors.MethodsThis cross-sectional study had randomly and systematically recruited facial burn patients from the Burn Care Center, Pakistan Institute of Medical Sciences, Islamabad, from June of 2016 to July of 2017. Intraoral examination recorded the DMFT, CPI and OHI-S. Information on the socio-demographic status, self-perceived oral health, oral health behaviours were collected using a self-administered questionnaire and; the burn characteristics were obtained from the patients’ medical record. The t-test, ANOVA, SLR, and chi-square test were used to examine the relationship between oral health and each factor. A parameter was derived from the clinical indices using the principal component analysis and used in the multiple linear regression analysis to determine the important factors associated with oral health status.ResultsA total of 271 burn patients (69% female and 31% male) had participated in the study. All of the participants had caries with mean DMFT = 10.96 (95%CI: 10.67, 11.25). There were 59.0% (95%CI: 53.15, 64.93%) and 66.1% (95%CI: 60.38, 71.73%) of the participants who had periodontitis and poor oral hygiene respectively. About 79 and 80% of the participants rated their dental and periodontal status as poor. About 78% reported brushing once daily and 89% did not practice regular dental visit. The DMFT, CPI and OHI-S were associated with the burn characteristics and oral health behaviours (p < 0.05). Dental anxiety, cost and social issues were the most cited reasons for not utilising oral health services. Greater burn severity, the longer time elapsed since the burn incident, and dental anxiety were associated with poorer oral health status and; brushing twice or more and regular dental visit, with better status (p < 0.01).ConclusionPatients with oro-facial burn injury had a generally poor oral health and, the risks are greater in those with a more severe and wider area of injury, the longer time elapsed since the burn incident and dental anxiety; but a good oral hygiene practice and regular dental visits were protective against the risk.

Improvement in Quality of Life and Activities of Daily Living in Patients with Liver Cirrhosis with the Use of Health Education and Patient Health Empowerment.

BackgroundThe management of quality of life (QoL) in patients with cirrhosis is important due to the chronic nature of compensated cirrhosis. The aim of the study was to evaluate the effect of health education using health empowerment theory in patients with liver cirrhosis.Material/MethodsBetween January 2014 and November 2014, 30 patients who were hospitalized with liver cirrhosis patients were recruited to the study, as the study group. Health education was conducted using the principles of health empowerment theory. Between January 2013 and November 2013, 30 hospitalized cirrhosis patients were recruited as the control group, who were given conventional health education. The QoL scores and Health-Promoting Lifestyle Profile II (HPLP II) scores were evaluated at hospital discharge and at two-month follow-up. The health knowledge awareness rate, activity of daily living (ADL), and health-promoting lifestyles were evaluated.ResultsOn discharge from the hospital, understanding of the major clinical symptoms, etiology, diet and nutrition, use of medication, treatment, and disease awareness rates were significantly higher in the study group compared with the control group (all P<0.05). There were significant differences in ADL scores between the two groups at two-month follow-up (81.5±15.5 vs. 68.5±15.4; P=0.006). All HPLP II scores were higher in the study group compared with the control group at hospital discharge and at two-month follow-up (all P<0.05).ConclusionsPatient health empowerment can improve the cognitive level and health behaviors of patients with liver cirrhosis, improve their ability to perform ADL, and improve their QoL.

Objective and perceived oral health status of elderly nursing home residents: a local survey in southern France.

ObjectiveThe aim of this study was to compare the perceived oral health of elderly persons and the clinical reality of their oral status.BackgroundPersons aged over 60 have considerable need for oral health care; a need that increases over time. However, this population appears to be unaware of their state of oral health, and this may be a further obstacle to professional management. We thought it useful to examine the objective and the perceived oral health of these patients. Understanding what may influence their perception can help us to improve their management.MethodsThe data analyzed in this work are the findings of a field survey carried out in elderly nursing home residents. Their objective oral health was evaluated by using two variables: oral profile, determined by clinical examination, and the oral health index determined using the Oral Health Assessment Tool (OHAT). Perceived oral health was evaluated using the various categories and fields of the General Oral Health Assessment Index (GOHAI).ResultsOur clinical study showed a discrepancy between perceived oral health and the clinical reality: although a significant association can be demonstrated between the OHAT and the GOHAI, there are considerable variations. It also appeared that the number of teeth and total edentation considerably influence perceived oral health and that findings vary according to different situations.ConclusionNumerous factors influence elderly persons’ perception of their true oral health. In order to improve our elders’ quality of life, the necessary measures must be taken for the follow-up and regular monitoring of their oral health. At the same time, all possible means should be used and awareness should be raised to improve the health behavior and perception of patients and their entourage.

A longitudinal examination of the interrelationships between multiple health behaviors in cancer patients

AbstractPurposeA healthy lifestyle following a cancer diagnosis is associated with reduced risk for a cancer recurrence. Better understanding the interrelationships between multiple health behaviors (HB) in cancer survivors could inform the development of more effective interventions to promote a healthy lifestyle.MethodsThis prospective study assessed the longitudinal interrelationships between smoking, physical activity, alcohol intake, and caffeine consumption among patients with mixed cancer sites at the peri‐operative period and 2, 6, 10, 14, and 18 months later. A cross‐lagged design and structural equation modeling were used to assess the relationships between all four HBs over time.ResultsThe study included 962 participants. The model showed a good fit to the data. For all four HBs, continuity paths consistently indicated that one particular health behavior was significantly predicted by the same health behavior at the previous time point. However, no consistent pattern of cross‐lagged relationships between HBs emerged. Physical activity at 14‐ and 18‐month evaluations was the HB most consistently involved either as a predictor as a predicted variable.ConclusionOverall, this study indicates that HBs assessed following cancer surgery are mostly independent and that interventions promoting HB changes during the cancer treatment trajectory need to target each health behavior separately.

Effect of patient motivation model on blood glucose management in patients with type 2 diabetes mellitus in community

Objective To investigate the effect of patient motivation model on blood glucose and quality of life in community type 2 diabetes mellitus (T2DM) patients. Methods The study recruited 258 eligible adult patients who were residents with health records from Waigang community health centers of Shanghai Jiading District. The subjects were randomly divided into incentive group (n=123) and control group(n=135). We established a cooperative pathway between community health care centers and general hospital, trained community health workers, equipped with the necessary clinical drugs, and finally, the Advance System for Diabetes Management was used to carry out the tele-medicine. The type 2 diabetic patients, who were set goals in blood glucose, managed by the general practitioners, the daily health behaviors of the patients were regulated. The study group received the incentives if they can obtain or/and maintain the ideal level of HbA1C during the 1-year study period. The control group would not receive any incentives but would be provided with diabetes education booklet and to follow group educational courses for diabetes mellitus control as usual. Results After 12 months, there were significant differences in HbA1C, fasting blood glucose, and the on-target rate of HbA1C in both two groups as compared with the baseline levels(P<0.05). In the investigation of quality of life(QOL), we found significant differences in the scores of total QOL, the degree of satisfaction, and the degree of influence between the incentive group and the control group one year after intervention(P<0.05). Conclusion The objective motivation model seems to exert a positive effect on blood glucose control and self-management for those with T2DM. Key words: Diabetes mellitus, type 2; Patient motivation model; Blood glucose; Quality of life; Self-management

High perceived social support and hospital readmissions in an older multi-ethnic, limited English proficiency, safety-net population

BackgroundEarly readmission amongst older safety-net hospitalized adults is costly. Interventions to prevent early readmission have had mixed success. The role of perceived social support is unclear. We examined the association of perceived social support in 30-day readmission or death in older adults admitted to a safety-net hospital.MethodsThis is an observational cohort study derived from the Support From Hospital to Home for Elders (SHHE) trial. Participants were community-dwelling English, Spanish and Chinese speaking older adults admitted to medicine wards at an urban safety-net hospital in San Francisco. We assessed perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS). We defined high social support as the highest quartile of MSPSS. We ascertained 30-day readmission and mortality based on a combination of participant self-report, hospital and death records. We used multiple/multivariable logistic regression to adjust for patient demographics, health status, and health behaviors. We tested for whether race/ethnicity modified the effect high social support had on 30-day readmission or death by including a race-social support interaction term.ResultsParticipants (n = 674) had mean age of 66.2 (SD 9.0), with 18.8% White, 24.8% Black, 31.9% Asian, and 19.3% Latino. The 30-day readmission or death rate was 15.0%. Those with high social support had half the odds of readmission or death than those with low social support (OR = 0.47, 95% CI 0.26–0.88). Interaction analyses revealed race modified this association; higher social support was protective against readmission or death among minorities (AOR = 0.35, 95% CI 0.16–0.76) but increased likelihood of readmission or death among Whites (AOR = 3.7, 95% CI 1.07–12.9).ConclusionIn older safety-net patients nearing discharge, high perceived social support may protect against 30-day readmission or death among minorities. Assessing patients’ social support may aid targeting of transitional care resources and intervention design. How perceived social support functions across racial/ethnic groups in health outcomes warrants further study.Trial registrationNIH trials registry number ClinicalTrials.gov: NCT01221532.

Perception of Health and Care Seeking Behaviors of Patients Living in High-Altitude Villages of Rural Nepal

Background: Nepal continues to struggle to increase its population access to healthcare, especially in rural and isolated villages where primary healthcare is offered through local health outposts. However, people often prefer to consult initially with traditional healers for minor issues as this is more aligned with their cultural beliefs and practices. Knowing that Nepal is undergoing healthcare reform, it would be timely to explore perceptions of health and care-seeking behaviors amongst patients living in high-altitude communities in rural Nepal for consideration in future planning and policy; which is the purpose of this qualitative study.&#x0D; Methods: In-person, semi-structured interviews were conducted, with the use of a translator, with 17 participants, living in two rural villages. After transcribing the interviews, themes were identified using thematic analysis.&#x0D; Results: People expressed the belief that they hold expertise in sustaining health due to their naturalistic lifestyle and community-focus developed within the context of a unique local culture and environment. When faced with a health problem, villagers are compelled to seek treatment from available healthcare offerings. Their care-seeking behavior and their eventual choice between Modern and Belief-based medicine is filtered through a number of considerations: the ease of its accessibility, the cost of services, their prior knowledge related to the illness, their belief system, and the severity of the medical situation.&#x0D; Conclusion: This study indicates that better understanding of the perceptions of the rural Nepali is crucial in advocating for sustainable and culturally-sensitive delivery of healthcare.&#x0D; Tweetable Abstract: Rural Nepali’s care-seeking behavior, rooted in naturalistic lifestyle and community-focus; however, contextual considerations oblige them to make choices between Modern and Belief-based medicine.

Health behaviour of elderly patients with heart failure in Poland associated with pharmacotherapy and non-pharmacological treatment

Health behaviour of elderly patients with heart failure in Poland associated with pharmacotherapy and non-pharmacological treatment

MON-190 Endo ECHO Improves Patient-Reported Measures of Access to Care, Health Care Quality, Self-Care Behaviors, and Overall Quality of Life for Patients with Complex Diabetes in Medically Underserved Areas of New Mexico

Background Individuals living with complex diabetes experience limited access to endocrine care due to a nationwide shortage of endocrinologists. Project ECHO (Extension for Community Healthcare Outcomes) is an innovative, scalable model of health care that extends specialty care to medically underserved areas through ongoing telementorship of community primary care providers (PCPs). The purpose of this study was to assess whether participation in the first iteration of the Endocrine ECHO (Endo ECHO) program resulted in changes to patient well-being, health behaviors and quality of care. Methods PCPs from 10 federally qualified health centers in NM participated in Endo ECHO, facilitated by a team of specialists at the University of New Mexico Health Sciences Center. Endo ECHO patients were eligible for the study if they were 18 years or older with “complex” diabetes: type 1 diabetes or type 2 diabetes and insulin dependent, and/or with an HbA1c of 9% or higher. Patients took a comprehensive survey during enrollment and again after one year. The Diabetes Comprehensive Care Clinic (DCCC) at UNM was included as a means of benchmarking specialized diabetes care, and a sample of DCCC patients completed surveys during the post-test time frame. We assessed ECHO patients for pre/post change using McNemar’s tests for paired data and then compared intervention group post-test scores to the DCCC patient scores. Results Five hundred thirty-three ECHO patients and completed pre and post surveys (62% response rate) and 139 DCCC patients completed surveys during the post survey period. At follow-up, 42% of ECHO patients reported their health status as excellent, very good or good at compared to 30% before program participation (p<0.0001), and 43% reported five or more days of physical activity per week, compared to 29% at baseline (p<0.0001). Endo ECHO patients reported more frequent provider-initiated tests for A1C (81% to 91%; p<0.0001), foot examinations (68% to 87%; p<0.0001), and eye exams (63% to 69%; p=0.0266), and 84% of patients felt confident in managing their blood sugar levels at follow-up compared to 62% at baseline (p<0.0001). Although Endo ECHO patients exhibited statistically significant improvements across all key measures at follow-up, they lagged behind DCCC patients in some areas, including positive health status (42% Endo ECHO post vs 68% DCCC), daily physical activity (43% ECHO post vs 50% DCCC) and daily blood sugar testing (70% ECHO post vs. 83% DCCC). Conclusions Endo ECHO appears to be effective means of improving the health and quality of life for patients with complex diabetes, although opportunities exist to further improve care as compared to care delivered at a university based specialty clinic. Endo ECHO may be a suitable alternative for patients in medically underserved communities where access to an endocrinology referral center is restricted.

What makes patients with diabetes adopt physical activity behaviors?—a transtheoretical model approach

Physical activity is an essential health behavior in patients with diabetes and is the one which is least adapted in the Indian context. There is a need to understand the motivators and demotivators of this behavior. This study was conducted to evaluate the stages of physical activity behavior change, process of change, decisional balance that influences the change and situational self-efficacy in patients with diabetes attending a tertiary care health facility in Chennai, India. Among 150 patients with diabetes attending the tertiary care hospital, selected in a non-random consecutive manner, a questionnaire-based survey was administered covering the domains of stage of change, process of change, decisional balance and situational self-efficacy. About 50% of the sample were not physically active belonging to the precontemplation or the reversal phase. About 23% were in the maintenance phase of physical activity and remaining 27% were in various intermediate stages of contemplation, preparation and action. The dominant dimensions of process of change were dramatic relief, self-re-evaluation and positive reinforcement. There was a high level of perceived pros of physical activity as well as cons and so there was a decisional balance not favouring either end of the behavior change spectrum. Situational self-efficacy levels were low. The perceived pros (OR 1.042; 95% CI 1.005–1.080) and cons (OR 0.929; 95% CI 0.877–0.985) influenced the behavior change in a statistically significant manner in a multivariate adjusted model. A very low proportion of patients with diabetes are in maintenance phase of physical activity with a majority in various stages of change. The patients show various processes of change which all help in moving them through the early stages of change. Perceived pros and cons influence the physical activity behavior change and measures taken to address them are likely to positively influence physical activity behavior.

Emotional Impact on Health Behavior Adherence After Bariatric Surgery: What About Positive Psychological Constructs?

Health behaviors are critical for weight loss maintenance after weight loss surgery (WLS), and emotional factors often play a role in adherence. Positive psychological constructs (e.g., optimism, positive affect) have predicted health outcomes in other medical populations but have been infrequently examined in post-WLS patients. This study measured optimism and positive affect in post-WLS patients recruited from online support groups. A hierarchical linear regression analysis tested their association with health behavior adherence, physical activity, and weight loss, controlling for demographic and weight-related covariates. It also tested depression and anxiety symptoms as moderators. In 95 participants, positive affect was associated with better adherence (b = 0.41, p < 0.01) and greater moderate-to-vigorous physical activity (b = 0.20, p < 0.001) controlling for demographic/weight-related covariates, and independently with more weight loss (b = 0.24, p < 0.05). Optimism was independently associated with better adherence (b = 0.32, p < 0.05) and with greater moderate-to-vigorous physical activity controlling for demographic/weight-related covariates (b = 0.16, p < 0.05). These associations no longer reached statistical significance controlling for depression and anxiety symptoms. Anxiety symptoms moderated the relationship between positive affect and adherence (b = 0.06, p < 0.01), and depression (b = 0.15, p < 0.01) and anxiety (b = 0.02, p < 0.05) symptoms each moderated the relationship between optimism and walking, such that there was a stronger relationship between positive psychological constructs and health behaviors for those with higher anxiety or depression scores. Positive psychological states should be included when assessing emotional factors related to health behaviors in post-WLS patients. Interventions targeting health behaviors may be improved with inclusion of skills to boost positive psychological states.